The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

• Published in: Health technology assessment (Winchester, England) England), 2016-09, Vol.20 (69), p.1-508
• Main Authors: Macdonald, Geraldine, Livingstone, Nuala, Hanratty, Jennifer, McCartan, Claire, Cotmore, Richard, Cary, Maria, Glaser, Danya, Byford, Sarah, Welton, Nicky J, Bosqui, Tania, Bowes, Lucy, Audrey, Suzanne, Mezey, Gill, Fisher, Helen L, Riches, Wendy, Churchill, Rachel
• Format: Article
• Language: English
• Subjects: Adolescent; Antipsychotic Agents - therapeutic use; Anxiety Disorders - therapy; Child; Child Abuse - psychology; Child Abuse - therapy; Child, Preschool; Clinical Trials as Topic; Cost-Benefit Analysis; Depression - therapy; evidence synthesis; Female; Humans; Infant; Infant, Newborn; Male; maltreatment; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental Disorders - therapy; Models, Econometric; Models, Psychological; Object Attachment; psychosocial intervention; Psychotherapy - methods; Quality of Life; Resilience, Psychological; Self-Injurious Behavior - therapy; Stress Disorders, Post-Traumatic - therapy; Stress, Psychological - therapy; Substance-Related Disorders - psychology; United Kingdom; Young Adult
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta20690

Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not p